Deaths from Various Causes: NHS Costs

Lord Rea asked Her Majesty's Government:

Further to the Written Answer of Lord McIntosh of Haringey of 12 January (WA 133), whether they can give the estimated GP attendance, days in hospital and overall costs to the NHS per annum in recent years arising from:
(a) road accidents
(b) accidents in the home
(c) smoking related illness
(d) alcohol related illness
(e) drug related illness
(f) AIDS
(g) food poisoning
(h) CJD; and
(i) mental illness.[HL117]

Baroness Jay of Paddington: The available information is set out as follows. Where information is from different sources, it is not necessarily comparable.

The department does not routinely collect information on the illness or injury that gives rise to a general practitioner consultation. The estimated rates of GP consultations that are presented come from a Morbidity Statistics from General Practice survey in England and Wales in 1992-92. This survey included 60 practices in England and Wales, covering about 1 per cent. of the population.

The number of days in hospital are available for some illnesses and injuries. The estimates of the total number of days in hospital in England, for all the conditions except mental illness and accidents in the home, have been obtained from the hospital episode statistics database (HES). Information on the number of days in hospital taken from different sources may not be comparable.

The department does not record the cost to the National Health Service of illness or injury, although estimates are available for certain illnesses and injuries. Costs are not directly comparable, as some are calculated on different bases.

27 Jan 1998 : Column WA26

(a) Road accidents

There were estimated to be 300,000 bed days in hospital in England during 1994-95 arising from road accidents. The Department of the Environment, Transport and the Regions estimates that in Great Britain in 1996, road accidents cost the NHS £490 million in hospital and community health services.

(b) Accidents in the home

The Department of Trade and Industry estimates that in the United Kingdom in 1995, there were 1,779,000 bed days in hospital resulting from accidents in the home.

(c) Smoking related illness

Many diseases can be attributable to smoking, such as cancers, heart disease and cerebrovascular disease, but smoking is not the only risk factor for these diseases. The cost to the NHS of treating people for diseases they developed as a result of their smoking is estimated to be between £1.4 and £1.7 billion in 1996 in England. These estimates were produced by the Centre for Health Economics at the University of York and the Health Education Authority. Expenditure on diseases to which smoking may make a contribution ("smoking related diseases") is necessarily higher.

(d) Alcohol related illness

It is very difficult to attribute the cause of any medical condition in any individual directly to alcohol. The diseases assumed to be related to alcohol in this reply are the same as those included in the Answer given by the Lord McIntosh of Haringey on 12 January (WA 133) and are listed as follows. However, these were selective and may not paint a full picture of the true extent of alcohol related activity. It is estimated that in England and Wales between September 1991 and August 1992 there were 60 GP consultations per 10,000 person years at risk arising from alcohol related illness. There were an estimated 1,022,000 bed days in hospital in England during 1994-95 arising from alcohol related illness. The Centre for Health Economics in York estimated that the costs of alcohol misuse to the NHS in 1994 of £164 million: this estimate was published by the Health Education Authority in 1997.

(e) Drug related illness

It is estimated that in England and Wales between September 1991 and August 1992 there were 107 GP consultations per 10,000 person years at risk arising from drug related illness. There were an estimated 190,000 bed days in hospital in England during 1994-95 arising from drug related illness. It is not possible to estimate the costs of drug related illness to the NHS. However, the National Treatment Outcome Research Study, which is tracking 1,100 drug misusers through treatment until 2000, will be providing an estimate of the costs of drugs misuse to the NHS. This will include the cost of drug related illness. The report of the first year follow-up of the cohort is expected to be available in spring 1998.

27 Jan 1998 : Column WA27

(f) AIDS

Information on the rates of GP consultation arising from AIDS is not available. It is estimated that in England in 1994-95 there were 10,000 bed days in hospital arising from AIDS. The following table shows the total amounts allocated to health authorities in England for HIV/AIDS treatment and care. The total amount spent may differ from these.

Year

Allocation for HIV/AIDS treatment and care

1996-97

£186 million

1997-98

£199 million

1998-99

£228 million

(g) Food poisoning

It is estimated that in England and Wales between September 1991 and August 1992 there were seven GP consultations per 10,000 person years at risk arising from food poisoning. There were an estimated 190,000 bed days in hospital in England during 1994-95 arising from food poisoning. Information is currently not available on the cost of food poisoning to the NHS.

(h) CJD

There is no reliable information available.

(i) Mental illness

It is estimated that in England and Wales between September 1991 and August 1992 there were 728 GP consultations per 10,000 person years at risk arising from mental illness. The following table shows the estimated number of bed days in hospital.

Year

Number of bed days in hospital

1994-95

15,600,000

1995-96

15,600,000

1996-97

15,500,000

The information on the number of bed days in hospital comes from the Department of Health's Common Information Core Data. The number of days in hospital on account of mental health include 3.2 million NHS-funding days in community occupied beds (i.e., in nursing, residential or group homes) in 1994-95. Comparable figures for 1995-96 and 1996-97 were 3.5 million and 3.7 million, respectively.

The following table shows the estimated cost to the hospital and community health services in England arising from mental illness.

Year

Cost to Hospital and Community Health Services

1994-95

£2,377 million

1995-96

£2,512 million

Source:

Hospital and Community Health Services programme budget analysis.

Disease definitions

Disease definitions are based on ICD9 (International Classification of Disease, Ninth revision) codes. Data were extracted for all codes relating to a particular disease. The codes used for each disease in this reply are listed as follows:

27 Jan 1998 : Column WA28

Illness or injury

ICD codes used for GP consultations and bed days in hospital

Road accidents

E810-E819, E826-E829

Alcohol related illness

303, 305.0, 291, 425.5, 571, 980

Drug related illness(1)

304, 305.2-305.9

AIDS(2)

279.1, 079.4

Food poisoning(3)

008.0, 003

Mental illness

290-319

(1) For drug related illness, the reply to the previous PQ (WA 113) also included E850, E858, E950.0-E950.5, E980.0-E980.5.

(2) For AIDS the reply to the previous PQ (WA 113) used ICDs 042-044.

(3) The estimated number of bed days in hospital arising from food poisoning also includes 038.4, 283.1, 557.0, 771.8.

Erroneous Refusal of Asylum: Restoration of Benefits

Earl Russell asked Her Majesty's Government:

Whether they will ensure that, when a refusal of asylum is found to be erroneous and withdrawn, the reinstatement of the claim also restores any rights to benefits which may have flowed from it.[HL18]

The Parliamentary Under-Secretary of State, Department of Social Security (Baroness Hollis of Heigham): Eligibility for income support and income based jobseeker's allowance is reviewed and revised from the date of refusal of asylum by the Home Office. Where the Home Office decision is subsequently found to be erroneous and withdrawn in circumstances which mean the adjudication officer's decision was based on a mistake as to a material fact, the adjudication officer will review and revise the termination of benefit under Section 25(1)(a) of the Social Security Administration Act 1992.

Habitual Residence Test

Earl Russell asked Her Majesty's Government:

Whether they accept the principle of Commissioner's Decision CIS/1067/1995 that habitual residence, once gained, is not lost after a temporary absence; and, if so, whether they will issue guidance to Adjudication Offices accordingly.[HL110]

27 Jan 1998 : Column WA29

Baroness Hollis of Heigham: Where a person spends time away from the United Kingdom, the adjudication officer should consider the frequency, length and purpose of absences abroad and decide whether habitual residence in the United Kingdom has been lost. Guidance to adjudication officers on the habitual residence test is contained in the Adjudication Officer's Guide at paragraph 20747 to 20748 and on temporary absence at paragraph 20940.